Premature ejaculation

How quickly a man ejaculates can vary massively. On average, men will ejaculate five to six minutes after penetration, although it can vary from one or two minutes to as much as eight minutes. There is no standard rule for it. However, the fact that very different expectations are raised in the corridors and in (porn) films can lead to a lot of confusion, uncertainty and frustration about this. 

A premature ejaculation occurs when the man ejaculates within a minute after penetration, and cannot delay it. 

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What is premature ejaculation? 

We speak of premature ejaculation if the following characteristics are present: 

  • If the man has already ejaculated before, or within one minute after vaginal penetration
  • If it is impossible for the man to slow down ejaculation
  • If there are strong negative consequences, such as stress, annoyance, frustration or even the avoidance of sexual intimacy

There are no exact figures on how often premature ejaculation occurs because it is still often seen as a taboo subject. It is estimated that between 3% and 30% of men suffer from premature ejaculation. 

Not even ten percent of men seek help for this, and that is a real shame. It often has a major impact on sex life, and people can therefore easily end up in a vicious circle. A good first step is to talk about it. This can be done with your partner, or with a doctor. 

What are the causes of premature ejaculation? 

For a long time it was thought that premature ejaculation was purely a psychological problem, but that does not seem to be the case. As with other sexual conditions, it seems to be a combination of factors. Fear and frustration can be a cause, and premature ejaculation can exacerbate these feelings and frustrations. This creates a vicious circle that is difficult to get out of. 

Other causes may be of a physical nature. For example, there are indications that an abnormality of the neurotransmitter serotonin, which causes signal transmission between nerve cells, may be the cause of premature ejaculation. Thyroid hormones also seem to play a role. For the time being, however, no major studies have been carried out into the physical backgrounds of premature ejaculation. 

Possible causes could be: 

  • Infections of the prostate
  • Thyroid disorders
  • Side effects of medicine use
  • Diabetes
  • Hypersensitivity of the male genitalia
  • Overweight
  • Hereditary properties
  • Emotional problems
  • Stress

Regardless of the causes of premature ejaculation, there is a good chance that the man, under pressure from his expectations, will become so tense that this alone is sufficient reason for premature ejaculation. 

What forms of premature ejaculation are there? 

In premature ejaculation, a distinction is made between primary premature ejaculation (men who have always suffered from premature ejaculation) and secondary premature ejaculation (men who previously had normal ejaculations). 

How can you recognise premature ejaculation? 

It is called premature ejaculation if you ejaculate in less than a minute after penetrating the vagina with the penis (or in case of anal sex, sucking or self-gratification), and you experience that you have no control over the ejaculation. This is not dangerous or unhealthy, it is only a 'condition' if it bothers you, if you have problems with it. 

Is there anything I can do myself about premature ejaculation? 

If medical reasons are excluded, you can try to regain control over your ejaculation yourself. There are various techniques for this, including the start-stop technique and the squeeze technique. 

The start-stop technique teaches you, together with your partner, to keep a close eye on your body reactions. This makes it easier to recognise when an ejaculation is approaching. Just before the point of the orgasmic reflex you stop stimulating the penis, which can cause the excitement to sink. When it is 'safe' again, and you are no longer about to ejaculate, you can start over again. With this method, you will become better at it over time and you can also add interesting variations to it. 

Another technique is the squeezing technique, in which you squeeze the penis with your thumb and index finger, just below the glans, just before you ejaculate. In most cases this interrupts the orgasmic reflex. 

Finally, you might consider trying to use breathing techniques to learn how to control the excitement. This is often more pleasant for the woman than the two previous techniques. 

Something we always recommend is to try to accept the situation as it is. There is no point in getting frustrated about this, and it is precisely this tension and frustration that can further exacerbate the problem. 

What are the forms of treatment? 

Medication 

At the moment there are three ways to deal with premature ejaculation with the help of medication: 

  • You can use medication to inhibit ejaculation; 
  • You can use medication to prevent your penis from weakening immediately after ejaculation; 
  • You can use medication to numb the head of your penis so that it is less likely to be stimulated. 

Medicines with the side effect of slowing down ejaculation

Currently, Dapoxetine is the only SSRI (selective serotonin reuptake agent) with indication, and is prescribed in case of premature ejaculation. 

Other SSRIs, selective serotonin reuptake inhibitors, also report a slower ejaculation as a side effect. Examples of SSRIs that can be used in premature ejaculation are paroxetine or sertraline. Officially, SSRIs are medicines for depression and anxiety, but you do not need to be depressed or anxious to use them to extend the time from penetrating the vagina to ejaculation. 

Medication to prevent the penis from weakening immediately after ejaculation

If there is no way to prevent premature ejaculation, or if you cannot or do not want to take SSRIs, you can choose to use a device that prevents the penis from weakening immediately after ejaculation. This allows you to penetrate even after orgasm. 

You can opt for an intra cavernous injection, in which a dose of papaverine/phentolamine or alprostadil is injected into the penis, or you can choose oral remedies, such as sildenafil, tadalafil or apomorphine. 

Products to numb the feeling of the penis

If you prefer not to take medication, if the SSRIs do not work, or if you are not allowed to use them for health reasons, you may want to consider a narcotic gel or cream. How it works is still uncertain and not scientifically proven, but it is worth a try. 

Use a lidocaine gel or lidocaine/prilocaine cream. Apply it to the head of your penis ten minutes before sex, then remove the gel. After all, you do not want your partner's vagina to get numb too. 

An important point of attention: The gel contains an oil that can damage condoms. You will therefore have to choose a different form of contraception. 

Alternative treatments 

You may want to consider behavioural or cognitive therapy. There is often a complex combination of psychological factors, especially in men with secondary premature ejaculation. For example, there may be fear of failure, sometimes due to sexual problems with a (former) partner or relationship problems. Sexological treatment or relationship therapy can help a lot. 

Performance pressure under the influence of the expectations created by films and books often makes it even more difficult to control your premature ejaculation. 

You can also be referred to a urologist. These specialists have various possibilities to treat preventive ejaculation at their disposal. 

The urologist may perform a short, non-painful physical examination of the penis, scrotum and sometimes prostate to rule out physical abnormalities. In addition, an internal ultrasound of the prostate and testicles can be made. And finally, to exclude thyroid diseases and prostate inflammation, a blood test and possibly a urine test will be carried out. 

With all the results in hand, the urologist can then work with you to determine which treatment or combination of treatments offers the best opportunities for you. In addition to medication, psychological or sexological help and psycho-education, pelvic physiotherapy or a combination of different treatment options can also be chosen. 

Lifestyle changes 

Some of the possible causes of premature ejaculation are obesity and stress. It is therefore advisable to adjust your lifestyle to be more healthy in order to tackle excess weight, and to build more peace into your life. 

Some tips for a healthy lifestyle: 

  1. Make sure you have enough exercise. Play sports, take a brisk evening walk. 
  2. Start with relaxing activities such as dancing lessons, yoga, meditation. 
  3. Do not overload your agenda. Keep space free to relax and unwind in between. Do this for your professional life, but also for your social life. Build in sufficient moments of rest. 
  4. Make sure you take on enough fluid. You may experience both physical and mental fatigue if your body is not properly hydrated. A well hydrated body can dispose of waste products quickly and well, which benefits your digestion. 
  5. Adapt your eating habits. Certain foods such as fatty meats, chips, mayonnaise, crisps, sweets and cakes require a lot of energy to process and lead to people being overweight. Eat enough fruit and vegetables, so that you also get enough vitamins and minerals. 

 

 

References

Albert Schweitzer Hospital (s.a.), Ejaculation too soon (premature ejaculation), consulted on 18 May 2019, at https://www.asz.nl/bekkenbodemcentrum/aandoeningen/seksuele-problemen/te-snel-klaarkomen--premature-ejaculatie-/ 

Nederlands Huisartsen Genootschap (2015), I'm coming too soon (man), consulted on 18 May 2019, on https://www.thuisarts.nl/snel-klaarkomen/ik-kom-te-snel-klaar-man 

Hond, Drs. H. de (z.j.), Early ejaculation, causes and treatment, consulted on 18 May 2019, on https://www.andros.nl/erectieproblemen/vroegtijdig-klaarkomen/ 

Hoogland, A. (2016), Ejaculatio praecox: premature ejaculation, consulted on 18 May 2019, at https://www.gezondheidsnet.nl/erectieproblemen/ejaculatio-praecox-vroegtijdige-zaadlozing 

Melod (2010), Dealing with premature ejaculation, consulted on 18 May 2019, at https://mens-en-gezondheid.infonu.nl/seksualiteit/32313-behandelen-premature-ejaculatie-voortijdig-klaarkomen.html 

Dutch Care Institute (z.j.) Dapoxetine, consulted on 18 May 2019, at https://www.farmacotherapeutischkompas.nl/bladeren/preparaatteksten/d/dapoxetine 

Nederlands Huisartsen Genootschap (s.a.), NHG-Standard sexual complaints (first revision), consulted on 18 May 2019, at https://www.nhg.org/?tmp-no-mobile=1&q=node/1772